Gliederung

Introduction

In transforaminal fullendoscopic operations of lumbar disc herniations a far lateral access is required to achieve a sufficient decompression of the ventral epidural space. Anatomical problems arise at the level L5/S1 due to the iliac crest. Therefore an interlaminar access was developed. Limitions appeared on technical side of endoscopes and instruments. The aim of this prospective study was to investigate the extended possibilities of the new endoscopes and instruments with regard to the efficacy of decompression.

Materials and Methods

512 patients with lumbar disc herniations have been treated in 2002 and 2003 in a fullendoscopic technique using a lateral or interlaminar access. A 7-mm endoscope with 4 mm-working canal and new designed instruments were used. Follow-up lasted at least 12 months. 415 patients (81%) could be followed.

Results

No intraoperative complication occurred. 9 patients reported a transient dysasthesia postoperatively. The average operation time was 28 minutes. A sufficient decompression could be achieved in all cases. 340 patients (82%) reported no more leg pain after surgery, 58 patients (14%) had transient persistence in the first 6 weeks. 8 patients (2,1%) showed a recurrent herniation, 7 of those were reoperated in the same technique.

Discussion

As a minimally invasive technique wich efficacy of decompression is equal to an open procedure we see advantages over conventional operations of lumbar disc herniations. The technical developments on endocopes and instruments lead to a decrease of recurrence, increase of mobility as well as the possibility of resection of hard tissue and sufficient cleaning of the intervertebral space.